Assumption of Risk/Waiver of Claim
I, _________________________________________________________________________, wish to participate in the Line Dancing Workshop offered by Hopkinton Recreation (Town of Hopkinton) .
I understand the importance of following all rules and regulations relating to this activity, including the instructions of the person or persons supervising this activity and/or the requirements of the person or entity responsible for the area where the activity takes place. I agree to follow and comply with all such rules, regulations, instructions and/or requirements.
I understand that it is important that I be in good physical condition when I engage in this activity, and I understand that it is my responsibility to maintain an activity level that is compatible with my physical condition and skill level.
I hereby expressly assume the risk of any physical injury or other loss that I might sustain as the result of participating in this activity and my transportation related thereto. I further understand there may be a risk of injury resulting in such program.
I also expressly waive and covenant not to sue on any claim I might have against the Town of Hopkinton or any employee, volunteer, or the estate or representatives of such person for any personal injury or loss I might sustain as the result of engaging in any activity relating to this program whether caused by negligence, breach of contact or otherwise; except that this wavier shall not apply to any claim I might have against the Town of Hopkinton or its agents for any such personal injury or loss I might sustain out of the gross or wanton negligence for any such person or entity.
PLEASE READ CAREFULLY BEFORE SIGNING
Signature of Participant Date
___________________________________________
Signature of Parent/Guardian
(If participant is under eighteen)
Name_______________________________________ Phone #___________________________________
Address________________________________________________________________________
Name of individual to contact in case of emergency: _____________________________________________
Phone # _____________________________________________
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